Research on Attire for Physical Therapists

I’ve seen some recent discussion on Twitter about attire for PT’s (including #NoPolo before and after CSM), and my employer is facing a possible change in requirements (we are allowed to be business casual or scrubs, with jeans on Fridays, but are now opening up a TCU within a hospital where the staff will be required to wear black scrubs). I thought I would pull up whatever research is out there for attire for physical therapists and briefly summarize each (there isn’t much!).

1999 masters thesis by Angell, Glaspie, and Winters – Physical Therapist Characteristics and Practices That Affect Patient Willingness to Comply With Home Exercise Programs. “The results of this study demonstrate physical therapist personality traits and clinical practices were perceived by patients to be more influential than appearance and role modeling behaviors.” Interesting conclusion and I would agree that it is more influential. Appearance, specifically professional dress and casual attire, did not reach a level of significance (the majority of respondents said it made no difference), but that is not to say that it might not matter. Table 3 appears to show a preference for professional>casual>lab coat, and professional attire and lab coat make gains with the older subjects when the subjects are separated into two age categories.

Ingram D, Fell N, Cotton S, Elder S, Hollis L. Patient preference, perceived practicality, and confidence associated with physical therapist attire: a preliminary study. PTJ ‐ PAL. 2011; 2‐8. I don’t have access to this paper, but their paper is included in Dr. Ingram’s NSC 2013 presentation What You Wear to Work: Appropriate Attire and Professional Image for Our Doctoring Profession. The most preferred attire by patients was scrubs, though OP’s and college educated patients preferred collared polo and khakis.

Finally Mercer E, MacKay-Lyons M, Conway N, Flynn J, Mercer C. Perceptions of outpatients regarding the attire of physiotherapists. Physiother Can. 2008;60:349-357. In ranking photographs of professionalism and preference of attire for a male model, for professionalism it was lab coat>tailored dress>scrubs>jeans, and for preference of attire it was tailored dress>scrubs>lab coat>jeans. For appropriateness of attire, it was tailored dress>scrubs>lab coat>jeans. Interestingly “in comparison to their younger counterparts, more respondents aged 56 years and above perceived scrubs on the male model as appropriate.” (note – appropriate, not preferred or professional). Also, “In contrast to the findings from medical literature, which indicate the lab coat as both most professional and most preferred, respondents in the present study unambiguously preferred tailored dress, despite regarding the lab coat as most professional.” Also, “Extent of exposure to this therapeutic interaction appears to influence patients’ perceptions of the appropriateness of attire. The study found that perceived appropriateness of lab coat and scrubs decreased and perceived appropriateness of jeans increased with increasing number of physiotherapy visits.”

So where does that leave us? First of all, you obviously have to follow the employer requirements. If you are in a hospital, you have no choice – scrubs are the standard, likely color-coded nowadays. Some of the large corporate OP clinics have a standard polo/ khaki combo. But if you are in a TCU/SNF or smaller OP clinic and there is just general guidance, what should you wear? I have chosen to wear professional attire (khakis and a button-down shirt) for two reasons – for the patient, and for me.

I would agree with Angell et al that it is more the characteristics of the therapist, not the clothing, that makes a difference for (at least) the HEP, but probably even from the moment we first meet. Still, I think that clothing does play a part in the interactions, for me and for them.The literature hints at patients preferring professional clothing (Angell), or certain segment of the population preferring it (Ingram), or they consider it to be more professional and preferred (Mercer). I also believe in dressing the part so to speak, and I think that is what Roush hints at. I know that I felt different Monday-Thursday than on a casual Friday when I used to wear jeans. Am I a better practitioner M-Th in professional attire than on casual Friday or M-F if I wear scrubs? Absolutely not! For me, I take my profession and my job more seriously than I do if I wear scrubs or jeans, and I feel more engaged.

I leave you with this from Mercer that I found interesting – “professionalism is a multifaceted construct that, in the health care field, encompasses the traits of competence; engagement (e.g., communication skills and empathy); reliability; dignity toward patients, peers, and self; placing the patient above self; and concern for quality of care. In more practical terms, it is ‘an image that promotes a successful relationship with the patient,’ such that the patient feels confident in the capabilities of the health care provider. Although professionalism is the single most important trait that can be enhanced by dressing appropriately, professional attire is only one means of achieving a successful relationship.” Personality traits and interactions play a significant role in the PT-patient relationship, and I want to use professional attire to help me maximize the interaction, for them and for me.